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Intravenous, deltoid, or gluteus administration of meperidine during labor?

  • Noam Lazebnik
    Correspondence
    Reprint requests: Noam Lazebnik, MD, Department of Obstetrics and Gynecology, Cleveland Metropolitan General Hospital, 3395 Scranton Rd., Cleveland, OH 44109.
    Affiliations
    Department of Obstetrics and Gynecology, Cleveland Metropolitan General Hospital, and the Perinatal Clinical Research Center, Case Western Reserve University, Cleveland, Ohio
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  • Betty R. Kuhnert
    Affiliations
    Department of Obstetrics and Gynecology, Cleveland Metropolitan General Hospital, and the Perinatal Clinical Research Center, Case Western Reserve University, Cleveland, Ohio
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  • Philip C. Carr
    Affiliations
    Department of Obstetrics and Gynecology, Cleveland Metropolitan General Hospital, and the Perinatal Clinical Research Center, Case Western Reserve University, Cleveland, Ohio
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  • Wayne T. Brashear
    Affiliations
    Department of Obstetrics and Gynecology, Cleveland Metropolitan General Hospital, and the Perinatal Clinical Research Center, Case Western Reserve University, Cleveland, Ohio
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  • Carol D. Syracuse
    Affiliations
    Department of Obstetrics and Gynecology, Cleveland Metropolitan General Hospital, and the Perinatal Clinical Research Center, Case Western Reserve University, Cleveland, Ohio
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  • Leon I. Mann
    Affiliations
    Department of Obstetrics and Gynecology, Cleveland Metropolitan General Hospital, and the Perinatal Clinical Research Center, Case Western Reserve University, Cleveland, Ohio
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      Abstract

      It has been suggested, but not well verified, that drug absorption from traditional intramuscular injection sites is altered during labor. This study tested the hypothesis that absorption of meperidine from the gluteus muscle would be impeded when compared with deltoid or intravenous administration. Five patients in labor were given 50 mg intravenously, 10 were given 50 mg in the gluteus muscle, and five were given 50 mg in the deltoid muscle. Five nonpregnant subjects served as their own controls for all three routes of administration. Blood samples were obtained at intervals after injection, meperidine was determined by gas chromatography/ mass spectrometry, and mean plasma levels of meperidine versus time after administration were plotted. Repeated measures analysis of variance was used to determine whether the curves were significantly different from 30 to 150 minutes. Maternal plasma levels after gluteus injection were significantly lower than those after intravenous injection (F[1,8] = 10.53; p < 0.01). In nonpregnant subjects, drug levels were not significantly different from 30 to 150 minutes after either gluteus or intravenous injection. Plasma levels after deltoid injection were always higher than those after gluteus injection in both pregnant and nonpregnant subjects (F[1,8] = 9.7; p < 0.02; F[1,8] = 14.5; p < 0.004). These findings support impaired absorption of drugs from the gluteus muscle and suggest the deltoid muscle as the favored intramuscular site during labor. (Ann J OBSTET GYNECOL 1989;160:1184-9.)

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